Julie WALLE
Over the past ten years, therapies through video games, virtual immersion, Internet applications and digital interfaces have been developing recently. One of the objectives of cognitivists and behaviourists is to think and build virtual spaces that generate emotion and are adapted to cognitive and behavioural reconstruction. Psychologists mainly use digital tools for exposure or cognitive remediation exercises. The flexibility of the support allows the reconstruction of realistic and modular scenarios according to the issues, objectives and individuals. Therapy is thus based on the work of cognitive-behavioural reactions in virtual situations and on the generalization of acquired knowledge in everyday life (Klinger, 2006).
During virtual reality exposure, the presentation of a stimulus triggers the apparition of emotions. The physiological and emotional responses recorded are essentially the same as in vivo exposure: hand sweating, increased heart rate, loss of balance, etc. Virtual exposure is mainly used, thanks to video-headsets or computers, to the treatment of phobic, eating, sexual, post-traumatic disorders, autism, palliative care services and cognitive rehabilitation. Anxiogenic situations of increasing intensity are proposed to the patient (Klinger, 2006). In cognitive remediation, Klinger (2006), for example, offers Parkinson’s subjects planning exercises in shopping situations in a virtual supermarket.
These two methods are similar to the mediatized experience. The subject learns to manage his or her emotions, thoughts and behaviours in challenges of increasing difficulty (Bandura, 1994). The therapist’s support and encouragement serve as social persuasion. In addition, the interface can indicate the level of performance or validate appropriate behaviours in a simulation with sounds or visual information on the screen. The controllable nature of these spaces secures the progress of the exposure sessions with the possibility of varying the intensity of the stimuli or shortening them in case of difficulty of the patient. The introduction of help signals during exercise promotes success and motivation. The digital tool makes up for some of the limitations of the therapeutic exercise “pencil paper”. It provides visual support that offers a form of control in exposure. The therapist is assured of the complete realization of the exercise. In imaginative exposure conditions, mentally accessing or maintaining concentration in the image of the distressing scene can be difficult for the subject (Klinger, 2006).
Virtual cognitive remediation experiments are also possible in imaginary contexts, such as video games. Radillo (2009) uses video games with deficient children as a systematic work support to facilitate “rehabilitation, training and rehabilitation”. According to him, the test provides information on the levels of impairment and the functions affected. However, it does not indicate the daily adaptive capacities on which cognitive remediation is based. The objective is to identify activities that cause difficulties and compensations that have already been used or can be used by the person. During the sessions, the child is heard cognitively, emotionally, socio-culturally (Radillo, 2009).
The intervention method used aims to rehabilitate the cognitive abilities of cognitively impaired individuals by consolidating or acquiring skills. When preparing the sessions, the psychologist selects video games that meet the therapeutic objectives. Radillo (2009) works with games that use seven specific cognitive abilities: selective attention, spatial location, fine motor visual control, body schematics, classifications, serializations, executive functions. In addition, it supplements the game time with other media to generalize and strengthen the link between actions and representations. The psychologist evaluates the results of his work by “generalizing what he has learned”, i.e. updating them on a daily basis (Radillo, 2009).
The recording of virtual activity, in environments designed for therapy and sometimes in some video games, is an additional advantage of the digital interface. It is an objective source of analysis of the performance achieved. The viewing of the scenes makes it possible to identify the reactions produced during the action in order to rework them and to observe the evolution of the therapeutic work. The detail of the action from various angles can be consulted several times and provides another reading of the difficulties or progress during the therapy (Klinger, 2006).
In short, the advantages of virtual therapy are linked to the real-virtual reactions produced in the patient, the feeling of presence during immersion, the emotional responses that result from it, the subject’s experience, the concentration on action, the transfer and generalization of knowledge, the prioritization, gradation and repetition of stimuli, and the flexibility of virtual reality (Klinger, 2006).
Bibliographical reference:
Bandura, A., & Wessels, S. (1994). Self-efficacy.
Klinger, E. (2006). Apport de la réalité virtuelle à la prise en charge de troubles cognitifs et comportementaux. Thèse de doctorat en informatique et réseaux, Ecole Nationale Supérieure des Télécommunications, Paris.
Radillo, A. (2009). L’expérimentation de l’utilisation des jeux vidéo en remédiation cognitive. Enfances & Psy, 44(3), 174. https://doi.org/10.3917/ep.044.0174
Words we have learnt: To triggers: déclencher; To record: enregistrer An impairment: un handicap, To Strengthen: renforcer, The prioritization = la hiérarchisation,